BOOKS OF RtfiDIfGS - PAHO/WHO

NUTTING ET AL.
audit instrument documents each contact
between the consumerand any component
of the provider system and captures the
date, location of contact, pro. ider of scrvices
and any of a predeterrined list of
services required to compute the indicator
results for that tracer. Whcn completed, the
audit instrument contains a complete profile
for that consumer of each contact with
every component of the provider system
and each of the relevant services provided.
The results for each of the indicators and
continuity-of-process scores for each function
or sequence of functions can be computed
from the completed audit.
Application of the Assessment Method
The assessment method has been
applied in 20 Service Units of the Indian
Health Service, three rural private practices
and two closed-panel health maintenance
organizations. Selected data is
presented from these appli itions to
demonstrate the major characteristics
of the method and some of the results
achieved.'
The first step in an analysis is to examine
the performance of each function. In one
- 128 - MEDICAL CARE
Service Unit of the Indian Health Service,
both population-based and encounterbased
indicators were employed to
examline the follow-up fimetion, using as
tracers iron-deficiency anemia, urinary
tract infection, laceration of the scalp and
extremities and prenatal care. Table 2
presents the follow-up criteria for each
tracer and the results aggregated across the
tracers. The consumer-provider contact
rate is population based and expresses the
percentage of patients due for follow-up
who made contact with the medical care
system during the time interval appropriate
for follow-up. The encounter-based
follow-up rate expresses the percentage of
patient encounters due for follow-up, in
which the follow-up criteria were. met.
Finally, the population-based follow-up
rate expresses the percentage of patients
due for follow-up who contacted the system
and received the follow-up services within
the appropriate time. The aggregate data
indicate that 71 per cent of patients make
contact with some component of the medical
care system when due, resulting in only
44 per cent of patients receiving follow-up
services. These results suggest that the relative
weakness in follow--up care is the sys-
TABLE 2. Examination of the Follow-up Function With Aggregate and
Tracer-Specific Data
Iron Urinary
Aggregate Deficiency Tract Prenatal
Follow-Up Funetion Results Anemia Infection Lacerations Care
Contact rate
(population-based) 71(921129) 58% (15/26) 63% (19/30) 65% (15/23) 86% (43/50f
Provision of
service rate
(encounter-based) 51% (57/112) 44% ( 7/16) 52% (12/23) 80% (12/15) 45% (26/58
Provision of
service rate
(population-based) 44% (57/129) 27% ( 7/26) 40% (12/30) 52% (12/23) 52% (26/50
Follow-up critena include:
Anemia-All patients placed on therapy should have a hematocrit or hemoglobin or reticulocyte coun
between three and six weeks of the initiation of therapy.
Urinary Tract Infection-All patients placed on antibiotic therapy should have a urine culture or micrc
scopic urinalysis within four weeks after therapy is completed.
Lacerations-All patients with a laceration requiring sutures should have an examination and documente.
statement of wound healing between 5 and 21 days after the sutures were applied.
Prenatal Care-All women delivering should have their blood pressiure documented and an examination o
the uterus between 2 and 10 weeks after delivery.